内容紹介
A Case of Recurrent Breast Cancer with Bone Metastasis Successfully Treated with Everolimus and Exemestane Therapy
Summary
We report a case of a patient treated with everolimus and exemestane combination therapy for bone metastasis after breast surgery. The patient, a 58-year-old woman, consulted our department for back pain in October 2014. She was diagnosed with left breast cancer when she was 41 years old. She had received Bt+Ax for left breast cancer and administered tamoxifen for 5 years. We decided on everolimus and exemestane combination therapy after observing an abnormal uptake in the 7th to 8th thoracic vertebrae on a PET-CT scan. The pain was controlled using oxycodone and fentanyl orally disintegrating tablet with zoledronic acid. After receiving treatment, the patient experienced pruritus and a Grade 2 rash, but they were managed with antihistamine administration and the treatment was continued. Four months later, the abnormal uptake on the right thoracic vertebrae shrunk; the pain almost disappeared, and oxycodone and fentanyl orally disintegrating tablet were discontinued. Subsequently, exemestane was used alone. Six months later, the range of abnormal uptake on the thoracic vertebrae progressed, and the disease was evaluated as PD. Four months later, everolimus and exemestane combination therapy was resumed, and the abnormal uptake on the thoracic vertebrae almost disappeared as observed on a PET scan. The effectiveness of the treatment was evaluated as CR because other local recurrence and new metastases were not found. Everolimus might exhibit bone resorption inhibiting effects and bone protection effects, but the decision regarding the periods of suitable use and the effects of long-term continuation of treatment are controversial, and further discussion based on experience of increasing use is required.
要旨
今回われわれは,エベロリムス/エキセメスタンを投与した乳癌術後骨転移の1例を経験した。症例は58歳,女性。41歳時,左乳癌にBt+Axが施行され5年間タモキシフェンが内服投与された。2014年10月中旬より背部痛が出現し当科へ紹介となった。PET-CTで第7～8胸椎に異常集積が認められ,エベロリムス/エキセメスタンを開始した。また,ゾレドロン酸を併用し疼痛に対してオキシコドン,フェンタニル口腔錠でコントロールした。Grade 2の皮疹・かゆみが出現したが,抗ヒスタミン剤にて軽減し内服は中止しなかった。治療開始後4か月後には,胸椎部の集積範囲は右側が縮小していた。疼痛もほぼ消失し,オキシコドン,フェンタニル口腔錠は中止とした。その後エキセメスタン単独で投与したところ,6か月後には胸椎への集積範囲は増大しPDとなった。そこでエベロリムス/エキセメスタンで再開したところ,その4か月後にはPETで胸椎への異常集積はほぼ消失していた。他の局所再発や転移を疑わせる新規病変も認められず,治療効果はCRと判定された。エベロリムスには骨吸収抑制効果,骨保護効果がある可能性があるものの,その至適投与期間の決定や治療効果をいかに長期継続できるかが課題であり,今後の症例を蓄積した検討が望まれる。
目次
Summary
We report a case of a patient treated with everolimus and exemestane combination therapy for bone metastasis after breast surgery. The patient, a 58-year-old woman, consulted our department for back pain in October 2014. She was diagnosed with left breast cancer when she was 41 years old. She had received Bt+Ax for left breast cancer and administered tamoxifen for 5 years. We decided on everolimus and exemestane combination therapy after observing an abnormal uptake in the 7th to 8th thoracic vertebrae on a PET-CT scan. The pain was controlled using oxycodone and fentanyl orally disintegrating tablet with zoledronic acid. After receiving treatment, the patient experienced pruritus and a Grade 2 rash, but they were managed with antihistamine administration and the treatment was continued. Four months later, the abnormal uptake on the right thoracic vertebrae shrunk; the pain almost disappeared, and oxycodone and fentanyl orally disintegrating tablet were discontinued. Subsequently, exemestane was used alone. Six months later, the range of abnormal uptake on the thoracic vertebrae progressed, and the disease was evaluated as PD. Four months later, everolimus and exemestane combination therapy was resumed, and the abnormal uptake on the thoracic vertebrae almost disappeared as observed on a PET scan. The effectiveness of the treatment was evaluated as CR because other local recurrence and new metastases were not found. Everolimus might exhibit bone resorption inhibiting effects and bone protection effects, but the decision regarding the periods of suitable use and the effects of long-term continuation of treatment are controversial, and further discussion based on experience of increasing use is required.
要旨
今回われわれは,エベロリムス/エキセメスタンを投与した乳癌術後骨転移の1例を経験した。症例は58歳,女性。41歳時,左乳癌にBt+Axが施行され5年間タモキシフェンが内服投与された。2014年10月中旬より背部痛が出現し当科へ紹介となった。PET-CTで第7～8胸椎に異常集積が認められ,エベロリムス/エキセメスタンを開始した。また,ゾレドロン酸を併用し疼痛に対してオキシコドン,フェンタニル口腔錠でコントロールした。Grade 2の皮疹・かゆみが出現したが,抗ヒスタミン剤にて軽減し内服は中止しなかった。治療開始後4か月後には,胸椎部の集積範囲は右側が縮小していた。疼痛もほぼ消失し,オキシコドン,フェンタニル口腔錠は中止とした。その後エキセメスタン単独で投与したところ,6か月後には胸椎への集積範囲は増大しPDとなった。そこでエベロリムス/エキセメスタンで再開したところ,その4か月後にはPETで胸椎への異常集積はほぼ消失していた。他の局所再発や転移を疑わせる新規病変も認められず,治療効果はCRと判定された。エベロリムスには骨吸収抑制効果,骨保護効果がある可能性があるものの,その至適投与期間の決定や治療効果をいかに長期継続できるかが課題であり,今後の症例を蓄積した検討が望まれる。